AB1761-HPR A TELE-MONITORING PROGRAM FOR TIGHT CONTROL OF TREATMENT SAFETY IN PATIENTS WITH RHEUMATIC DISEASES
Authors: M. Fedeli, J. Saini, H. Ibsen, M. James, T. Hügle
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Initiation of an immuno-modulatory treatment is a vulnerable part of the patient journey. Distance monitoring via patient reported outcomes (PROs) and wearables are used to assess treatment efficacy. In combination with remote vital sign measurement and tele-nursing, remote care may also increase safety and save resources. However, it is unclear how such telemedicine services integrate into the clinical workflow. <h3>Objectives</h3> Feasibility and User Experience (UX) study of a combined app-based and nurse-assisted tele-monitoring program in rheumatic patients with different risk profiles starting a new biologic treatment. <h3>Methods</h3> In this quantitative and qualitative study, we explored a distance monitoring service including contactless optical vital sign measurement and tele-nursing in ambulatory rheumatic patients in Switzerland. System Usability Scores (SUS) and semi-structured interviews were performed with patients, tele-nurses, and rheumatologists. Patients collected weekly PROs and vital signs via an app (Vtuls, Switzerland) after instruction by tele-nurses. Vital sign deterioration triggered automated notification (categorized in yellow, green, and red) allowing corrective actions. Rheumatologists received monthly summaries of PRO and vital signs in PDF form. <h3>Results</h3> 15 patients with rheumatoid arthritis or spondylarthritis with a mean age of 43.9 years (32-79) were included and monitored up to three months with the app and phone calls of the tele-nurse. 15/15 patients found the program useful, mainly for staying in contact with their rheumatologist after therapy start or switch. 13/15 patients measured their vital signs regularly, the adherence to PRO questionnaires was significantly lower. 6 patients had technical problems with the contactless blood pressure measurement. The app generated in average 16 vital sign alarms per patient, of those 7.1 green, 1.1 yellow and 2.2 red alarms. The rheumatologists considered the program as useful, especially in one patient with high-level comorbidity who experienced infection and in another patient after dosing error of the new treatment. The number of consultations (e.g. routine control 1-2 months after starting the new treatment) were significantly lower in this cohort compared to patients without remote care. PDF reports via email were considered as suboptimal and digital integration into the workflow needs to be implemented in future versions of the care program. Tele-nurses considered patients with high comorbidity, shorter disease duration and younger age as most suitable for remote control. False alarms initially increased the workload of the nurses, but this later reduced through technical advice and adjustment of the thresholds. SUS scores were slightly higher in patients (median 97.5) compared to tele-nurses (median 77.5). One patient outlier (17.5) had higher expectations in the responsiveness of tele-nursing, based on entered PROs. <h3>Conclusion</h3> Tight remote control of safety and efficacy through a combined app, biosensor and tele-nursing program was appreciated by all stakeholders, especially in patients with high comorbidity. A better integration of data and communication in the clinical workflow is required, ideally through the electronic medical record. A reduced workload in the rheumatology clinic was observed, but a complete reorganization of the processes was necessary. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Marco Fedeli: None declared, Jas Saini Shareholder of: Board of directors at Vtuls, Henrik Ibsen Shareholder of: Board of director Opentelehealth, Miriam James Employee of: Mediservice AG, Thomas Hügle Shareholder of: Scientific board member at Vtuls, Consultant of: GSK, Novartis, Medac., Grant/research support from: Fresenius Kabi, Eli Lilly, Abbvie.